Treatment of gunshot wounds of the spine using full-endoscopic surgery: analysis of a small clinical series

Objective. To assess the effectiveness of the treatment of gunshot wounds of the spine using percutaneous full-endoscopic technique.

Material and Methods. Three patients with gunshot shrapnel wounds of the spine were treated using percutaneous full endoscopy.

Results. The patients underwent a removal of foreign bodies (metal fragments) at the cervical, thoracic and lumbosacral levels of the spine using percutaneous full endoscopic surgery. The operations were carried out without complications, with minimal additional trauma to soft tissues and the spinal motion segment. In all three cases, there was a positive dynamics in the form of regression of the pain syndrome. There were no infectious complications.

Conclusion. The successful use of percutaneous full endoscopy in the surgical treatment of blind shrapnel wounds of the spine is shown. The results indicate the expediency of further research and development of this area to address the issue of introducing the technique into the routine practice of treating gunshot wounds both in peacetime in neurosurgical hospitals and centers of spinal neurosurgery, and in wartime at the stages of specialized care.

[Comparison of transpedicular endoscopic sequestrectomy and discectomy in the treatment of lumbar intervertebral disc herniation with a high degree of migration]

BACKGROUND

Surgical treatment of intervertebral disc herniation with a high degree of migration (beyond the vertebral pedicle) is a difficult problem without an unambiguous solution. In this manuscript, we compare the effectiveness of transpedicular endoscopy and standard discectomy in the treatment of patients with this disease.

OBJECTIVE

To compare transpedicular endoscopic sequestrectomy and discectomy in the treatment of lumbar intervertebral disc herniation with a high degree of migration.

MATERIAL AND METHODS

There were 28 patients divided into 2 groups: group 1 - 13 patients after transpedicular endoscopic sequestrectomy, group 2 - 15 patients after discectomy.

RESULTS

Transpedicular endoscopic sequestrectomy ensured significantly better intraoperative parameters (incision length, blood loss, surgery time) (p<0.01). In both groups, postoperative VAS score of leg pain was significantly reduced within a day after surgery from 7.4±1.3 to 0.7±0.7 and from 7.1±1 to 0.8±0.5, respectively. In the 1^st group, VAS score of back pain regressed from 5.2±0.7 to 1.1±0.89 by the end of the 1^st postoperative day. This value was 0.6±0.5 a year later. In the 2^nd group, VAS score of back pain regressed from 4.9±1 to 2.5±0.9 by the end of the 1^st postoperative day. This value was 2.8±2.3 a year later. According to McNab clinical outcome scale, excellent and good results after transpedicular endoscopic sequestrectomy were obtained in all 13 (100%) patients, after discectomy - in 80% of cases.

CONCLUSION

Transpedicular endoscopic sequestrectomy is optimal for intervertebral disc herniation with a high degree of migration due to fast postoperative recovery and no complications.